Hi everyone this is equal parts question and information. In short, by law, everyone in Japan is required to pay for national health insurance based on your ability to pay through your level of income. In reality, after about four years of paying it, they suddenly doubled my monthly bill. I went to the city and explained I couldn't afford it and they politely said: "there's nothing we can do". Years later the city is now demanding payment on YEARS of health insurance I didn't use because I opted to change to private health insurance. It's like going to a restaurant and them giving you a bill for all the meals you haven't eaten there in the last 5 or 10 years. I'm looking for advice as to what to do from others who are experiencing the same thing. There are thousands of foreigners in Japan who like myself, are refusing to pay for a service we don't use or benefit from. There are many foreigners who refuse to pay it on the basis that they have private health insurance and the payment is supposed to include old age pension. The issue is while in theory, those payments should either lead to pension payments here upon retirement ( after 25 years of paying in ) or be transferred back to my home country when I return. In reality, there is no clear or established procedure ( aka you will probably NEVER see any of the money you contributed ever again:-? ). In my case, I just tried to get permanent residence, and they said "no", in essence, meaning that they are happy to let me stay as long as I pay taxes, but that I won't be allowed to stay after that. So any money I pay into their system, I almost certainly never see again:-?